16559 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
" CITY OF CUPERTINO 16559
INSPECTION DIVISION
JOB INSPECTION RECORD.
PERMIT EXPIRATION
JOB ADDRESS SCK q ji,4812--1 TIG UNIT# _LOT#
, 1 PERMIT EXPIRES IF WORK
OWNER j Iv CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF _ 'LRMfT VALIDATION
CUPERTINO STANDARDS.
GARAGESLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
_ UNDERGROUND /SLAB
PLUMBING. '� +�•!� i'
ELECTRICAL ISSUANCE DATE
BLDG ELECT PLG. MEC.
MECHANICAL � r ❑ ❑ •�' ❑
DO NOT POUR FLOOR UNTIL-ABGVE HAS BEEN SIGNED BUILDIN PERMIT
INFORMATION
WOOD FLOOR
VALUATION $/FT.
PLUMBING
MECHANICAL sv
PERMIT TO
ELECTRICAL QQQ `
FRAMING .- C ,' �9V " L
Jpe<i"`Bvua T Pe coNSTR
INSULATION
:hl Q1 OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT EI.00R AH CA T7AT,ALHEAGf
ROOF I NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
ow DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE,
ROOF SHEATHING .Es IND cON PB DO—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El ❑ ❑ ❑ ❑
ASSESSCRS PARCEL NO
ROUGH SAN.a
PLUMBING ELECT.ENERGY
TRACT NO YAHCLL NO
TUBS&SHOWER PAN . PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC DATE ACC FILE NO
ELECTRICAL - BUILDING ENERGY
FRAMING ELECT,FINAL TEST ZONING ENG SITE NO.
INSULATION PLUMBING
GAS TEST GAS
FIRE SPRINK ENERGY T-]<
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y E] O N[—] ❑I N
. ❑.
FLOOD zuNE A,L u:c.
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR ' - FIRE DEPT. v� N� YLJ NEI
SHEETROCK GRADE FEESUMMARY
EXTERIOR LATH BUILDING
BUILDING
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
F
GAS EE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Lu ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING G
00 PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
— SEE PERMIT FOR EXPIRATION DATE MECHANICAL
—
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE 'TOTAL lqoo
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
• BZS
ROJECT I DENTI FICATION 'PERMIT NUMBER
BUILDING
APPLICATION & PERMIT 16559
ADORE - BUILDING
-
ELECTRICAL-PLUMBING-MECHANICAL
OWNER 'J �y/^`/� PLAN CHECK VALIDATION
NAMEVY, ELECTRIC PERMIT FEE
PHONE
cONTRUTLETS-SWITCHES-RECEP 10.00/1.00
NA
Ad51 LIC.N LIGHTING FIXTURES 10.00/1.00
)DOES5 CraR's PPLIANCES-RESIDENTIAL 4.00
E5 7 _ '
C "HONE / PANELS 10.00 PATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH.08 ENG. 500 PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT .
. ZIP EMP.METER OR POLE INS. 20.00
APPLICANT S MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE
D o o LICENSED CONTRACTORS DECLARATION
¢v I lemby alEnn that 1 am licensed under PlmViSiOIIsof Chapter9 ISSUAN EDATE
H 4 w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. P G. MECH.
H D 2 Profession Cod u n license is in full for (f •7 ❑ ❑ ❑
z O y- License Cl.s' _ Lic.Nutria,
¢y Date Contractor
ERMIT
w ¢ OWNER�BUILDHR DECLARATION BUIL OR TION
U REFER TO ORD INFORMATION
wLL N I hemby affnn that I um exempt from Ere Contractor's License MISC.- VALUATION
Hu '0 0< Law for lire following rcuson.ISec.7031.5.Businessand Professions PERMIT ISSUANCE 10.00
Code:Any city c r county which requires a permit to construct,alter,
2 ¢s- Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. -
O IS requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
d w m" he is licensed pursuant to the provisions of the Contractor's License n
HiQ
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe IV
4 D Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
at H Cr the basis for the alleged exemption.Any violation of5eetion 7031.5 STORIES TYPE CONSTR.
dam - by any applicant for permit subjects tire applicant On civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($5000.):
O I,as..all of the property.or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 DCO.GROUP RES.UNITS
/ their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Basiness and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:'fire Contractors License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5A. 0 ) psa ET.FLOOR AREAJ TOTAL ACREAGE
^� ment,am hof intended
ownemployees.for sale.
If,ed that however.
the
improve GAS-EA.SYSTEM-I INC.4 OUTLETS 6. 0 p
mems arc not into sold or offered for sale.If,however,the building
or improvement is rwithin one your of completion,the owner- GAS-EASYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will love firee burden of proving that he did not build or im' . R 0 IND CON PR Omer
prove to,Purpose of sine). INDUSTRIAL WASTE INTER. 30.00 (k� El El 1:1 11❑ I,as owner of the property,a n exclusively contracting with p
licensed contractors to construct the project(See,7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 \ ASSESSORS PARCEL NO.
and Professions Cndc:'Piro Contractor's License Law docs not apply
to an owner of property who builds or improves thereon,andwho LAWN SPRINKLERS-OVER 5(EA.)
1.001•
contracts for such projects with a coutmctor(s)licensed pursuant to
the Contractor's License L.W. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT No. PARCEL NO.
❑ I;,n,excmpr under Sec, ,B.&P.C.for this WATER HEATER W/VENT 6.00 A A20
Crux 11
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 Itereby affirm that I have a certificate of conunt to self-insure. ZONING
or a certificate of Workers'Compensation Insunce ora certifieJ ENG.SITE NO.
ra
copy 0,LabC.)
Policy u �([Pmr, •(6CL/
Q ❑ Cer11 If yis hereby furnished. FIRESPRINK ENERGY T 24
Z_ Z ❑ CCrY d ' Ry f cit w'Ih tlrc tY I coli division. MISC.- REFER TO ORD. / y❑ N❑ Y ❑ N❑
O Applica
I- n PERMIT ISSUANCE i&60 4100 FLOOD ZONE A.L.U.C.
CC :RTIFICA'I'li OF li%E?IPTION P WORKF RS'
LU _ COMPENSATION INSURANCE PLG,CONTR. LIC.NO.
d ❑ (This section need not be completed if the permit is for one TOPLG.TAL A�ee Y❑ NO Y❑ NO
::) Z hundred dollars IS 100)or less)
U O 1'certify that in the performance of file work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
UL H mit is issued,1 shall riot employ any Personin any manner so as to
O w become subject to the Workers'Compensation Laws of California. BUILDING
Date Applicant ALTER OR ADD TO MECH. 5.00
} m NOTICE '1'0 APPLICANT': If,after making this Certificate of Iix-
F 2 traffics,you should became subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
,,visions oI'Alm Labor Code, you must forthwith comply with FEE
V such provisions or this permit 0.11 be deemed revoked. AIR HANDLING UNIT(TO 10000C.F.M.) 4.00
CONS]'RUCI'ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the Performance of tire work for which this permit is issued(Sec. MICROFILM
3097,Cie.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address- HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC .
1 certify that I have read fhis application and state that the above VENTILATION FAN (SINGLE) 4.00
• information n correct. I agree m comply with all oily and county PLUMBING (�
ordinances and slate lows refining to building construction, andmy BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby autho De representatives of this city to enter upon the BOILER-COMP love,100,000 BTU)SEE FEE SCH. MECHANICAL
ahove-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
PERMIT ISSUANCE 10.00
may in any way accragainst said City in consequence of the
ue
ling ofthis pennE. MECH.CONT. LIC.NO. MECH.
4� TOTAL TOTAL ) 7
m p aunt/Con I
/
OFFICE COPY
MAURO
Stationers, Inc.